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Impact of Mucinous Histology on the Prognosis of Stage I-III Adenocarcinomas of the Appendix: a Population-Based, Propensity Score-Matched Analysis

Bernhard Widmann, Rene Warschkow, Bruno Schmied, Lukas Marti & Thomas Steffen

abstract

BACKGROUND
Whereas the poor prognosis of signet ring cell adenocarcinomas of the appendix is well known, the significance of mucinous histology remains unclear. The aim of this population-based study was to evaluate if mucinous histology is an independent prognostic factor in appendiceal adenocarcinomas.

METHODS
Patients with stage I-III adenocarcinoma of the appendix who underwent surgery between 2004 and 2012 were identified in the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cancer-specific survival (CSS) were assessed using risk-adjusted Cox proportional hazards regression models and propensity score methods.

RESULTS
Overall, 980 patients with appendix cancer were included, of which 449 (45.8 %) had a mucinous histology. In an unadjusted analysis, the 5-year OS and CSS in patients with a mucinous adenocarcinoma (MC) was 76.8 % (95 % confidence interval (95 %CI): 72.1-81.7 %) and 81.0 % (95 %CI: 76.6-85.6 %), respectively, compared with 70.0 % (95 %CI: 65.1-75.3 %) and 76.2 % (95 %CI: 71.5-81.2 %) in patients with non-mucinous adenocarcinoma (NMC) (P = 0.082 and P = 0.368). In multivariable analysis, no impact on survival was observed for OS (HR = 1.22, 95 %CI: 0.89-1.68, P = 0.208) and CSS (HR = 1.21, 95 %CI: 0.84-1.74, P = 0.296). After propensity score matching, nearly identical survival rates were observed (OS: HR = 1.03, 95 %CI: 0.71-1.49, P = 0.881 and CSS: HR = 1.05, 95 %CI: 0.70-1.59, P = 0.803).

CONCLUSIONS
The present population-based, propensity score matched analysis shows that mucinous histology does not affect survival in stage I-III appendiceal adenocarcinoma patients. Therefore, the same treatment strategies can be applied for patients with NMC and MC of the appendix.
   
citation Widmann B, Warschkow R, Schmied B, Marti L, Steffen T. Impact of Mucinous Histology on the Prognosis of Stage I-III Adenocarcinomas of the Appendix: a Population-Based, Propensity Score-Matched Analysis. J Gastrointest Surg 2016; 20:1493-502.
   
type journal paper/review (English)
date of publishing 27-4-2016
journal title J Gastrointest Surg (20/8)
ISSN electronic 1873-4626
pages 1493-502
PubMed 27120448
DOI 10.1007/s11605-016-3148-5
contact Ulrich Beutner